Customizing Physiologic Alarms in the Emergency Department: A Regression Discontinuity, Quality Improvement Study.
Liane Y Fujita, So Yung Choi
PMID 31864768WHAT IT FOUND
An emergency department alarm bundle of default-setting changes, nurse education, customization, vital-sign mode, oximetry sensors, and ongoing feedback reduced the weekly alarm-fire rate by 14.96.
Nurses reported more meaningful alarms, but patient harm was not measured.
Key findings
01After a bundle that included emergency-department-specific monitor default settings, nurse education to customize alarms, vital-sign mode use, oximetry sensors, and posted alarm feedback, the weekly alarm-fire rate fell by 14.96 (p=.003).
02For 7 months post-intervention, there were no patient safety reports related to physiological alarms.
03Emergency department staff nurses reported identifying more potentially serious and meaningful alarms after non-actionable or nuisance alarms were eliminated.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only total alarm fires were counted, not whether they were clinically non-actionable, so the reduction could include actionable alarms. The number of individual patients analysed is not reported; alarm data were aggregated for monitored beds by week. This was one emergency department, one monitoring system, and a before-after design with a historic control period, not randomisation or concurrent comparison. The post-intervention period was 6 months, shorter than planned, and alarm rates began trending upward after intervention, though not significantly. The intervention was a bundle of default changes, education, customization, vital-sign mode, oximetry sensors, and feedback, so the contribution of any single component cannot be separated. 82% of nurses documented training, and super-user coverage was not scheduled for every shift, so exposure to the intervention varied.
Declared interests
The authors report no conflict of interest.
The easy way to misread this
Do not conclude that customizing alarms alone reduced alarm fires or improved patient safety. The project changed monitor defaults, nurse education, customization, vital-sign mode, oximetry sensors, and feedback together; it counted total alarms rather than non-actionable alarms; and it had no patient-level safety outcome.